Evidence in bariatric surgery (part 1)

[Evidence in bariatric surgery (part 1)]

DO WE HAVE ENOUGH EVIDENCE TO SUPPORT BARIATRIC SURGERY (PART I)

We are dealing with a key-question: do we have a level of evidence that is strong enough to support bariatric surgery in 2007 ? Let us remind the definition: the level of evidence can be classified in three stages. Level A (the strongest) is based on thorough surveys, e.g. powerful randomized comparative trials (randomized means that two groups of patients are selected) and/or meta-analysis (i.e. comprehensive review of several former publications);Level B is based on other valuable studies such as less powerful comparative trials, or non randomized studies that are well documented; Level C concerns other proofs such as regular series of patients.

Before geting into the details of different publications and surgical procedures, let us state that by and large the answer is a yes. A sufficient level of evidence is available in order to convince health care providers to allow mini-invasive bariatric surgery for motivated patients, provided they meet the IFSO-criteria. There is no other reason than the lack of funding to deny it under these circumstances*. There is not today sufficient evidence to support the claim for obesity surgery for every single morbid obese patient. There is no alternative option to less invasiness if we wish the bariatric field to grow furthermore, and even be extended to non morbid obese patients (BMI <40, or between 30 and 35 with comorbidities). Even if surgery has evolved from the time when the SOS study was initiated, it is still perceived as somehow aggressive. Non invasive, if possible endoscopic procedures are the only way to perform controlled and randomized studies in the future, thus eliminating the bias of current surveys. Physicians who are dedicated to obesity, as well as companies making surgical devices should invest money and time in this purpose rather than in lobbying towards a reluctant public opinion.